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Surgical treatment of hourglass-like radial nerve constrictions - 22/02/21

Doi : 10.1016/j.neuchi.2021.01.010 
W. Qi a, Y. Shen a, b, Y. Qiu b, S. Jiang a, b, Y. Yu c, H. Yin a, b, , W. Xu a, b, c, d, e, f
a Department of Hand Surgery, Shanghai Medical College, Fudan University, Huashan Hospital, 12, Wulumuqi Middle Road, 200040 Shanghai, China 
b Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China 
c State key laboratory of medical neurobiology, Fudan University, Shanghai, China 
d National Clinical Research Center for Aging and Medicine, Fudan University, Huashan Hospital, Shanghai, China 
e Priority Among Priorities of Shanghai Municipal Clinical Medicine Center, Shanghai, China 
f Institute of Engineering and Application Technology, Fudan University, Shanghai, China 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 22 February 2021
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Abstract

Introduction

Spontaneous radial nerve palsy with the surgical revelation of an hourglass-like constriction is a complicated condition. In general, the surgical strategy is decided in accordance with the results of surgical exploration. This study aimed to investigate the efficacies of various choices of surgical methods in the treatment of hourglass-like radial nerve constrictions.

Material and methods

Ten patients with spontaneous radial nerve palsy undergoing surgical exploration with the revelation of hourglass-like constrictions between November 2010 and December 2018 were reviewed in our hospital. Preoperative physical, electrophysiological and ultrasound examinations were performed for all patients. Varying levels, degrees and numbers of radial nerve constrictions were shown by surgical exposure. Epineurectomy and interfascicular neurolysis were performed in 4 cases with incomplete constrictions; resection and primary suture repair in 2 radial nerves with neurotmesis; resection and autologous nerve grafting in 4 patients with nerve defect>2cm. Both motor and sensory evaluations were performed at a follow-up visit.

Results

Ten patients underwent different history before the onset of symptom. Nerve ultrasound demonstrated swelling as well as constrictions of the radial nerve. All patients who were followed up presented with good to excellent recovery of motor function. The effectiveness of suture and autograft repair tended to be better than that of simple neurolysis.

Conclusion

The etiology of hourglass-like fascicular constrictive neuropathy of radial nerve involve with torsional factors. Nerve ultrasound is an important and useful measurement in diagnosing the pathology of spontaneous radial nerve palsy and in helping determine surgical approach. The surgical intervention is beneficial for the patients who do not recover in 4 weeks after onset of symptoms and for severe hourglass-like constrictions that are confirmed by preoperative ultrasound imaging. We recommend that nerve grafting be a suitable method in confrontation of nerve defect>2cm.

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Keywords : Radial nerve, Hourglass-like constriction, Surgical treatment


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